Management

Hormone Therapy for the Transgender Male Adolescent

Editors: Mala S. Sivanandy MD; Esther Jolanda van Zuuren MD; Alan Ehrlich MD, FAAFP

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Background Information

Description

  • pubertal suppression therapy followed by gender-affirming masculinizing hormone therapy is used to promote development of male secondary sex characteristics and suppress/minimize female secondary sex characteristics
    5
  • puberty-suppressing hormone therapy and masculinizing hormone therapy are both considered medically necessary gender-affirming interventions
    1
  • goals of hormone therapy are
    2
    • to reduce endogenous sex hormone levels, and thus reduce secondary sex characteristics of individual's designated gender
    • to replace endogenous sex hormone levels consistent with individual's gender identity by using principles of hormone replacement treatment of patients with hypogonadism
  • goals of medical gender-affirming interventions are
    3
    • to reduce gender dysphoria by aligning physical sex characteristics with gender identity in a manner that enables transgender people to more easily blend into society as their affirmed gender
    • to reduce need for surgical interventions to reverse otherwise permanent changes of endogenous puberty

Definitions

  • gender identity refers to an individual's deeply felt, internal, intrinsic sense of their own gender
    1
  • gender expression refers to how an individual enacts or expresses their gender in daily life within their cultural and societal context
    1
  • gender dysphoria refers to discomfort or distress caused by discrepancy between sex assigned at birth and gender identity
    1
    ,
    2
  • gender incongruence refers to an individual's marked and persistent experience of incompatibility between their gender identity and sex assigned at birth
    1
  • gender diverse refers to descriptions of people with gender identities and/or expression that differ from social and cultural expectations attributed to their sex assigned at birth
    1
  • transgender (or trans) refers to gender identity and/or gender expression that is not typically what is expected for their sex assigned at birth
    1
  • transgender male refers to male gender identity in a person assigned female sex at birth (may also be referred to as trans boy/man or boy/man of trans experience)
    1
  • nonbinary refers to individuals who experience gender outside the gender binary, including people who
    1
    • experience gender comprised of ≥ 1 gender identities simultaneously or at different times
    • do not have or have neutral (that is, agender or neutrois) gender identity
    • have gender identities encompassing or blending elements of other genders
    • have gender identity that changes over time
  • gender-affirming treatment/therapies/interventions refers to procedures that help patients be recognized or affirmed in their gender identity
    1
  • transition refers to the process by which a person changes from gender expression associated with sex assigned at birth to gender expression that better matches their gender identity
    1
  • detransition refers to an individual's retransition to gender stereotypically associated with sex assigned at birth
    1

Tanner Staging in Patients Assigned Female at Birth

  • Tanner staging system (also known as the sexual maturity rating) is used to monitor development of secondary sexual characteristics
    table iconTable 2. Tanner Staging in Patients Assigned Female at Birth
    Table 2: Tanner Staging in Patients Assigned Female at Birth
    Stage Breast Pubic Hair
    1(Prepubertal) No palpable breast tissue, B1 None, PH1
    2 Breast bud, elevation of papilla, enlargement of areolar diameter, B2 (thelarche) Sparse, fine, straight, lightly pigmented hair along medial border of labia, PH2
    3 Breast enlargement, contour not separate from areola, B3 Moderate darker, coarser, curlier hair extends over midpubis, PH3
    4 Areola and papilla project above breast, forming secondary mound, B4 Adult-type hair, but does not extend to inner thigh, PH4
    5 (Adult) Areola recesses to match contour of breast, papilla projects beyond breast contour, B5 Adult-type hair extends to inner thigh, PH5
    Abbreviations: B, breast stage; PH, pubic hair.
    PubMed25124201Primary carePrim Care20140901413465-87465Reference - Prim Care 2014 Sep;41(3):465, Pediatr Rev 2011 Jul;32(7):281.
  • see Female Puberty for additional information
  • see also Male Puberty for Tanner staging in patients assigned male at birth
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